A Rare Case: Segmental Testicular Infarction

Abstract

IntroductionTesticular infarction is usually observed globally, and its most common causative factor is testicular torsion. Testicular adnexa, acute epididymitis, and epididymo-orchitis can be included in the differential diagnosis. Strangulated inguinal hernia, segmental testicular infarction, testicular tumor, and idiopathic scrotal edema are among the rarer causes of acute scrotum. Global infarction is a diagnosis of urologic emergency. Segmental testicular infarction is a rare case, and it is seen in the second and fourth decades of life. Although its clinical symptom is similar to testicular torsion in the beginning, late acute stages and radiological images can be mixed with testicular tumors. Therefore, it may result in radical intervention. In the early period, it is observed as a heterogeneous hypoechoic focus with an unclear margin. Infection, trauma, tumors, bleeding, iatrogenic causes, and torsion are responsible for its etiology (1). In our study, we aimed to present the case of a patient in whom we conducted partial orchiectomy due to the presence of testicular mass lesion and whose pathology result was indicative of segmental testicular infarction. Case ReportA 32-year-old male patient applied our clinic due to left testicular pain. No pathology could be detected in his scrotal examination. It was learned from his anamnesis that he had undergone left varicocelectomy a year ago, and his pain had begun afterward; it was also learned that he was infertile. The results of requested laboratory analyses were normal. A 18×15-mm mass lesion inside the left testis without hypoechoic heterogeneous internal blood supply was observed on performing scrotal Doppler ultrasonography (GE Healthcare®; USA) and the right testis was observed to be normal. A 2-cm mass lesion not displaying apparent contrast enhancement in T2 sequences was observed when pelvic magnetic resonance imaging (MRI) (Siemens® Germany) in the patient with a pre-diagnosis of testicular tumor (Figure 1). No pathological lymph node was observed. Tumor marker levels were normal (lactic acid dehydrogenase : 98 U/L, alpha-fetoprotein: 1.92 ng/mL, and serum beta human chorionic gonadotropin: <1.2 mIU/mL). He was found to have oligospermia based on his spermiogram.A decision of perform partial orchiectomy was made as there was no blood supply and contrast enhancement, his tumor marker levels were normal, he was infertile, and his tumor burden was below 30%. Informed consent was obtained from the patient. The layers were opened via a inguinal incision under general anesthesia. The testicle was passed through, and the tunica vaginalis and albuginea were opened. The lesion described in the radiological images was palpated in the testicle. It was opened (Figure 2) and removed after excising it from the surrounding tissues (Figure 3). Biopsies were taken from around the lesion. The defect that occurred was primarily closed (Figure 4). The patient was discharged without A Rare Case: Segmental Testicular Infarction Bu çalışmada nadir rastlanan segmental enfa...

Case Report: Segmental Testicular Infarction

“…Segmental testicular infarction is a rare condition of undetermined aetiology. Cases are often idiopathic although there are case reports suggesting a history of trauma, the presence of infection or an underlying vasculitis may be potential causes [2,3]. The most common symptom in segmental testicular infarction is acute testicular pain.…”